Multiple issues - help!

Hi all,

I just discovered this forum and am so hopeful someone can help me!

My son is 5 weeks old. He was 5 lbs 13 oz at birth; he is now 6 lbs 5 oz. He gained 8 oz. in the past 17 days. Initially I thought breastfeeding was going great - he seemed to latch on well right away, and I had little pain. He fed for a long time - often over an hour - but I thought that was normal. Since birth I have aimed to feed him every 2 - 3 hours from the start of the last feed, though at night around 3 weeks I started letting him wake us up at night, rather than waking him up - he rarely sleeps more than a 3 hour stretch.

When he was 2 weeks old we went to a lactation support group just to see if everything was going okay. Though the IBCLC thought his latch was good, she weighed him after he fed on each breast and said he wasn't getting nearly enough (I can't remember how much). She also said she thought he had a tongue tie. I decided to wait on doing anything, since he has always made tons of wet and soiled diapers and seemed contented. Well, at around 4 weeks I started feeling like his extended feeding times weren't normal - he feeds for well over an hour if I let him - and lately when he drops off, as soon as he wakes up he seems discontented and is crying etc until I put him back on. We went through a couple days of green stools last week, but generally his stools have always been bright yellow and seedy.

We decided to get the tongue tie "released" on Friday morning, and though the latch seemed somewhat deeper right away, I haven't noticed a difference in feeding time. Additionally, he continues to seem frustrated anytime he's not sleeping or eating.

I have been pumping - once in the morning for the past week or so, and recently in the afternoon too - just to set up a stockpile and also because I've been nervous that the tongue tie will reduce supply. In the a.m. I can get 2 oz out of each breast. This afternoon I got a bit over 1 oz on one "full" breast, and let Sam (my son) nurse on the other side. Then I pumped the other side when he seemed done and was able to get about a 3/4 oz.

I feel like this isn't a supply issue but I'm not sure - think it might be more a feeding issue. He also gets tremendously fussy on the breast sometimes - on either - will cry and arch his back when feeding, especially in the evening when he does his cluster feeds. We do burp him often and he will burp, but doesn't have a ton of spit up.

I'm not sure what to do here - our doctor is concerned he's not gaining enough, and I am concerned that he seems always hungry, even with his hour long feeds, and seems to be acting weird while feeding - as though he can't quite latch, always. Sometimes it's fine, but in the evenings especially he starts pushing out the nipple with his tongue and seems so frustrated. This has been true before and after cutting the tongue tie.

I am feeding him about 10v times a day; we get about 2-3 soiled diapers (often more) and many wet diapers a day.

Also we've been using our finger to let him suck when he's really fussy but we know he's full - is this going to mess up his ability to latch onto the breast? Relatedly, I'd like to offer him a bottle soonish but am concerned it will make his issues at the breast worse, but it will help him gain. What should I do???? I'm getting so discouraged and confused with the multiple issues.

Re: Multiple issues - help!

I think you need more data. Moms are cautioned against drawing big conclusions from a single weigh-feed-weigh session, because milk intake varies a lot from feeding to feeding. Is renting a professional baby scale a possibility for you? This has to be something which is accurate to the 1/10th of an oz. if you do weigh-feed-weigh records for every (or most) feeding(s) for a couple of days, you will gain a much more reliable picture of how much your LO can take in at the breast.

Aside from the low weight gain, everything sounds pretty normal. Your LO's diaper output sounds good, and long feedings and fussiness, particular evening fussiness, are textbook normal for this age. Has baby always been weighed in the nude, using the same scale? And was there any weight done in between birth and this most recent weight? Also, did you have lots of IV fluids during birth?

Re: Multiple issues - help!

We did do another weigh-in after a feed at the doctor's office; rather than weighing after he fed on each breast we did it after both, and I believe he'd taken in 1.5 oz - maybe a bit less. That was when he was just around 3 weeks old. We were going to a few different places for awhile (2 different doctors and lactation consultants) so he was weighed on different scales, but now we're just going to one doctor, and he is weighed in the nude. I did get an IV for about 3 hours before he was born.

Is this a really low weight gain? That's one question I have.... I know he's not gaining a ton, but neither my husband and I are very big. We both have pretty speedy metabolisms.

Is the output from the pumping okay? I pumped today about 20 minutes after a feed and was only able to get 2 1/2 oz total (from both breasts - one, which was more full, was 1 1/2 oz - the other, which he'd been feeding on before, was 1 oz).

Lastly, what should I do regarding bottles and pacifiers / finger to suck on? Should I be avoiding introducing those things?

Last night he seemed to be able to feed more efficiently than before, and I was excited about that - I am hoping that the frenulectomy will start to help soon. But he does still seem hungry....

Re: Multiple issues - help!

On average, babies in the 0-4 month age bracket gain around 5-8.5 oz per week (see http://kellymom.com/bf/normal/weight-gain/). So in a 2 week time span you'd want a baby to gain at least 10 oz, and your baby gained just 8 in 17 days. Now, your baby's diaper output sounds good, and your pumping output is fine, and there were probably a lot of different scales in the mix here that might explain apparent low gain (e.g. if one scale reads high and the other reads low). But I think there is cause for concern here, just based on the slow feeds, tongue-thrusting behavior, and the slow gain. I'd really recommend getting the scale for home use, so that you can gather the data that I think you need. Because your baby is painting 2 different pictures- on the one hand, he's going slow with weight gain but on the other hand everything else seems pretty normal. An accurate assessment of his nursing intake should help you figure out which picture is the right one. Definitely don't rely on that single weigh-feed-weigh measurement at the doc's office, because the amount the baby takes in at any given feeding can be much higher or much lower than average.

Since you have this concern over weight gain, I think the paci and finger should be shelved for now. You want all baby's suckling to be done at the breast, because even when a baby is "just" comfort sucking he may still trasnfer some milk, and that may be milk he needs.

Re: Multiple issues - help!

You don't mention pain when nursing-do you have any? I am assuming not in what I suggest below...

My son is 5 weeks old. He was 5 lbs 13 oz at birth; he is now 6 lbs 5 oz. He gained 8 oz. in the past 17 days.

As mommal notes, Yes this is slow weight gain for a newborn, taken as a whole. Generally speaking, it is suggested that baby should be back up to birth weight by two weeks of age and gaining about 6 ounces (or more) per week after that (later-in a couple months, it slows down.) But the only way to tell if baby is gaining ok now is to do weight checks fairly frequently (once a week? ) And accurately. To do accurate weight checks, 1) they always have to be on the same scale 2) they always have to be with baby naked. 3) Health care practitioner AND mom should both read and write down the weight and 4) ask your hcp to do a double check-weighing baby twice just to be sure all was done correctly.

Is the output from the pumping okay? I pumped today about 20 minutes after a feed and was only able to get 2 1/2 oz total (from both breasts - one, which was more full, was 1 1/2 oz - the other, which he'd been feeding on before, was 1 oz).

That is entirely normal pump output. In fact it’s slightly on the high side of normal. A typical nursing session at this age, baby should transfer between 2 and 4 ounces, and if baby is nursing around the clock and feeding normally, anything you pump is ‘extra.’

I agree with mommal, The very slow gain does not quite fit with the normal output (poops) you record. Also, if tt or any other breastfeeding issues were causing issues with baby getting enough milk, then the way to tell if that is getting better is to do weight checks now that are accurate.

It can be normal for a newborn to take an hour to nurse, and certainly if baby has milk transfer issues due to tt or poor latch for any reason, it may take longer for baby to get enough.

And newborns (up to 6 to 8 weeks or so) typically need to nurse a minimum of 10 -12 times a day. More often is normal. Often a baby will want to cluster nurse-nurse very frequently for several sessions, then take a longer break, Again, normal. So I suspect that with the every three hour schedule, baby was maybe not nursing quite that often?

The good news is, once the early newborn period is over and breastfeeding is going well (any problems addressed) nursing session begin to become generally faster and somewhat less frequent, making breastfeeding much easier and even convenient! Much more convenient than bottle feeding. It really does get easier!

I would suggest at this point 1) if you have never seen an IBCLC for a private consult or saw one but did not find it helpful, you consider seeing one or a different one. If you want suggestions for finding one, let us know.
2) Pacifiers- Avoid pacifiers, absolutely, except in emergencies-in the car for example. Contrary to popular belief, You WANT your baby to "use the breast as a pacifier." This is a normal part of breastfeeding and allows for normal milk production and baby getting enough milk.
3) Bottles- Avoid unless baby needs to have supplemental feedings. Does your baby need to be supplemented? That is between you and your doctor. If baby needs supplements, bottles are one way to go, but there are other options for getting supplements into baby, if you don’t know what those are let us know. If you are supplementing, it is important to pump as well to get/keep milk production normal. Also of course them your baby could be supplemented at least in part with your own expressed milk.
4) if your baby had trouble with milk transfer, that may have harmed your milk production. Your pump output is so good this is unlikely, however, it’s something to consider. You could consider some of the many techniques for increasing production.
5) Breast compressions may help shorten feedings somewhat.
6) Nurse very frequently-12 times a day. You appear to be making milk. Nurse frequently to get that good milk into baby!

Re: Multiple issues - help!

So we began giving my son two bottles of expressed breast milk a day at our doctor's insistence, and in the hopes that he will gain more, become a better / more efficient feeder, and then I can go back to mostly nursing (with just occasional bottle use when I need to be gone). We have been giving anywhere from 3 - 5 oz a day for the past week, total, and he gained 6 oz in 4 days and seems much, much more content! He also doesn't appear to have any problems going between breast and bottle- fingers crossed! The milk we used at first was frozen from just pumping in the am (was trying to build a stockpile) - now is whatever I can pump that day- I've been pumping for about fifteen min after 3-4 feeds a day, getting anywhere from 3/4 - 1 1/2 oz total from both breasts.

This is a short term strategy that leads to lots of questions. I am doing this on top of nursing just as often as before - which he seems fine with, with one exception. I nurse , as before, 9 - 10 times a day - I know lilmeg said to nurse 12 times a day but that's hard to pull off when his feeds sometimes last 1 1/2 hrs - and I do want him to take some naps in the day - I am nursing on demand but sometimes take him on walks etc where he sleeps and I get a longer stretch between feeds. We have been giving the second, larger bottle before bed - typically 2-3 oz. - in addition to me nursing a lot in the evenings. But twice now he's slept for 5 hours after, which is great for me but concerns me. What will this do to my nighttime supply? Will it diminish if he does this a couple times a week? What happens when we want to stop doing the bottle at night - will my body make enough again to keep up with middle of the night feeds? Last night he still woke up every 2-3 hrs but tonight he just gave me another 5 hr stretch. His feeds are also getting shorter at night.

He does seem to be getting a bit more efficient at the breast and his latch is stronger- seems more satisfied after less time (although still nurses sometimes for over an hour). We also haven't had that problem where he doesn't seem to know what to do with the nipple except two days after introducing the bottle - one night he had trouble but has been fine since. I also seem to pump less after he feeds than before - I'm hoping the frenulectomy is starting to help and he's learning to work his newly freed tongue and doing a better job of "emptying"? But am concerned it could be a supply problem too - yesterday in the a.m. I was only able to get 1 oz total from pumping both breasts about twenty min after he fed. If it is a supply issue won't the increased pumping help?

How long should we keep doing the bottle feeds? I'm nervous about how he'll respond when we stop.

Thanks in advance for your help. We have talked to two lactation consultants - one at a support group and another who is a friend who is in training. But we are both in grad school and can't afford a private consult so I am doing what I can to get info on the boards and talking to our doc etc....

Re: Multiple issues - help!

So baby is now gaining quite well with the two bottles totaling an extra 3-5 ounces, plus nursing 9 or 10 times a day. (EDIT of course 4 days is a very short time to draw any conclusions about anything from but for now lets assume this is a big step in the right direction, growth wise)

3-5 ounces milk in bottles would represent about 2 good transfer and 3 not as good transfer nursing sessions.

To my mind, it would be easier and less potentially problematic to simply nurse the generally reccomended amount of times MOST baby's this age need to nurse, so you can get off the pumping and bottles, and simply nurse, until there is a need for bottles due to separations. I do not understand why you are worrying about naps or stretching times out between feeds. Are you really worried your baby is not sleeping enough? Barring some very unusual health issue, a baby WILL SLEEP as much as it needs to unless baby is being literally tortured to stay awake.

The original concern as I understand it was if baby was getting enough. Now baby is certainly getting enough, based on weight gain. This is great! Why are you wanting to buy trouble just so your baby will nurse on some scedule that is not normal for any 5 week old baby?

Babies this age who are gaining adequately typically nurse a MINIMUM of 10 -12 times a day. A few may nurse only 8 and gain fine, even 6, but that is really rare. But others nurse 16, and in some places where no one owns a clock and babies are held by thier mothers and nursed routinely as the mothers work and go about thier lives, most of the babies nurse about 20 times a day. It depends on many factors-babies ability to extract milk, mothers breast capacity, production, even culture. All babies and all mothers are slightly different, and even exactly what each baby needs to take in each day is different.

That is why sceduling or worrying overmuch about the length of nursing sessions or if they are too frequent can be deadly to breastfeeding. Barring some health issue that makes baby overly sleepy or lethargic, a baby cues to nurse when a baby needs to and nurses as long as baby needs to. IF a baby is not gaining well, the simplest and most effective first step is to encourage baby to nurse more often.

Maybe your baby really only needs to gain around 3-4 ounces in four days to be healthy, not 6, and neither the extra bottles nor additional nursing sessions are needed. I don't know. But frequent nursing session are entirely normal and needed, according to breastfeeding researchers, not me. This is simply the reality of having a newborn baby.

Last edited by @llli*lllmeg; April 18th, 2013 at 10:38 AM.
Reason: edit in top line

Re: Multiple issues - help!

Originally Posted by @llli*hadleymonroe

This is a short term strategy that leads to lots of questions. I am doing this on top of nursing just as often as before - which he seems fine with, with one exception. I nurse , as before, 9 - 10 times a day - I know lilmeg said to nurse 12 times a day but that's hard to pull off when his feeds sometimes last 1 1/2 hrs -

What is he doing during these long feedings? Is he nursing actively the whole time, or is he spending a lot of the time dozing and giving shallow, erratic "comfort" sucks?

and I do want him to take some naps in the day - I am nursing on demand but sometimes take him on walks etc where he sleeps and I get a longer stretch between feeds.

Are you thinking about naps because you're looking for well-deserved break from baby care, or are you concerned that baby isn't getting "enough" sleep? If it's the former, tell us about how and where you nurse the baby, and let's see if we can get you a break while still having the baby nurse a little more. If it's the latter, please don't worry. A new baby's sleep needs can be met in all sorts of different ways- there are babies who sleep while nursing, babies who take long, well-defined naps, babies who cat-nap, etc.

We have been giving the second, larger bottle before bed - typically 2-3 oz. - in addition to me nursing a lot in the evenings. But twice now he's slept for 5 hours after, which is great for me but concerns me. What will this do to my nighttime supply? Will it diminish if he does this a couple times a week?

Anytime you go a longer stretch without nursing, your supply will diminish to some degree. There's no telling how much because it's very individual- some moms have very robust milk supplies that take a lot of time to diminish, other moms have very responsive supplies that will dip if they skip just a few feedings.

What happens when we want to stop doing the bottle at night - will my body make enough again to keep up with middle of the night feeds?

Assuming the baby is a good nurser, he should be able to bring your supply right back up when you stop the nighttime bottles. Supply = demand. Anytime the baby needs more and consequently demands more, supply goes right back up.

But am concerned it could be a supply problem too - yesterday in the a.m. I was only able to get 1 oz total from pumping both breasts about twenty min after he fed. If it is a supply issue won't the increased pumping help?

Increased pumping will always help supply. Just don't expect an overnight effect. It's not like you're going to pump 1 oz today and 5 oz tomorrow. Expect a more gradual increase. Maybe today you get an oz, tomorrow you'll get another oz, the day after that you'll get an oz and a quarter, and so on.

How long should we keep doing the bottle feeds? I'm nervous about how he'll respond when we stop.

When's the next weight check? If the baby continues to gain weight at a normal pace, you can probably start phasing out the supplemental bottles fairly soon. You're not using that much supplement, over all.

Re: Multiple issues - help!

Mommal's responses are more on point. Please just ignore my last post. Rereading it, I think it comes off as snippy, which was not my intent but it happens. I realize now I feel frustrated becasue I don't think you really needed to pump OR give your baby bottles, and having seen the mischief bottles and pumping can cause, doctors making mothers pump and/or give bottles needlessly always frustrates me. And in fact it is already causing mischief because you ar getting needlessly worried about milk production based on pump output which is not a good indication of milk production.

But that is not my call and of course I could be totally, completely wrong. You and your doctor need to do what you think best and clearly this intervention worked for the weight gain, anyway, as baby appears to be gaining well.

Re: Multiple issues - help!

We weighed him today and he gained 3 oz since Monday - in 3 days. He had been gaining just 4 oz a WEEK (not in four days) which is why we were concerned. This week he's gained 9 oz!!

I AM nursing him on demand. I am not watching the clock or doing a schedule and never have. However, as I said, if he is nursing over an hour at a time, it is hard to do 12 feedings a day, because there are times when he sleeps for 3 hours, and there are times when I do want a break - to take a walk with him, for example, which is when he naps. I am sorry but I am doing the absolute BEST I possibly can, and even if it is supposedly normal for a baby to nurse 10 - 12 times a day, my son really seems to want to nurse 9 times a day. That's only 1 under what's "typical" and I don't think it's that off (sorry, but that post did sound snippy - and not what I needed to hear! I am really working hard here, and I know that frequent nursing is normal for a newborn, trust me!!! However, nursing for an hour and fifteen minutes 12 times a day is more burden than I can handle. Especially if my baby is not gaining weight well, and I can supplement for a short time with exclusively breastmilk. Period.)

I also don't know why giving a bottle or pumping is necessarily bad, if it's working for us. The bottles have seemed to make him happy and aren't compromising how he's nursing. So can't it be ok for a short while?

Also, I know that you're trying to be helpful but sometimes there are conflicting things you hear from lactation consultants etc which help confuse the issue. For example, people say that pumping output isn't a good indicator of milk production - but all over these boards when someone says they are pumping a certain amount, the reply will be that (as it was here) it seems they don't have a problem with milk supply. So presumably there would be an amount to pump which WOULD indicate a problem with supply? Then I hear that your breasts are never "empty", but people tell you to let a baby finish one side in order to "empty" the breast - I know they mean relatively speaking, but it's frustrating nonetheless.

As for the other questions: during the hour long (or hour fifteen) feeds he is nursing actively throughout most of it; he starts comfort sucking / shallow sucking only towards the very end, last ten or so minutes maybe (it varies of course). I was concerned about naps because he wasn't sleeping during the day very much at all for awhile until I started paying attention to getting him down twice - no cat naps, not sleeping while nursing, etc., and from what I have read a newborn should not be awake for more than 4 hrs without sleeping at all. He is a happier baby who sleeps better at night when I make sure he gets at least 2 naps in (whenever they happen - it varies).